Local Factors Should Drive School Reopening Decisions, Health Experts Say

Duke faculty discuss complexity of reopening schools with media

Part of the From Health Care to Child Care, the Impact of COVID-19 Series

The decision to reopen schools is complicated and nuanced and should consider the specific needs and public health situations of individual communities, Duke health experts said Tuesday.

Speaking to reporters during a virtual media briefing, two pediatricians and an applied economist explained the many difficult aspects to consider when deciding whether to reopen schools to children this fall.

Video from the full briefing is available here.

Here are excerpts:

ON HOW TO APPROACH SCHOOL OPENING DECISIONS

Dr. Charlene Wong, primary care pediatrician

“There’s a really strong case for trying to reopen schools because there are so many benefits both for children, not only their academic benefits, but also their health and wellbeing and social/emotional health … and also for families, many of whom are trying to get back to work and reopen the economy.”

“We really need to proceed with caution and care and avoid broad, sweeping mandates about requiring schools to open. We are certainly very early in learning about the experience of children and their experiences, particularly in schools and other congregant settings.”

“While we’ve seen an explosion of COVID-19 research and we’re learning something new every day, a relatively small proportion of that research has been on children.”

“When thinking about the different age groups of children and what we’re seeing, it seems the virus behaves a little bit differently in younger children. Also, what families are able to do in terms of separating a high school student more from the rest of the family compared to a younger child.”

“There’s a lot of difference.”

Lisa Gennetian, economist

“When we think about school openings and closings, we should really think hard about the function of schools in these communities. They’re not just environments for learning. They also offer a number of things (such as child care). They also serve as accessible places for distribution of services. Recently, it’s been food, stepping up as the most cohesive system in our country to distribute food, as well as food banks and faith-based communities.” 

“Access to psychological support. Teachers and professional staff as part of schools are important gatekeepers to detect neglect and to help support children with services outside the school environment. Schools also offer some stability in the context of disruption.”

Dr. Ibukun Christine Akinboyo, pediatrician, infectious disease specialist

“Who critically needs to be in person, and who can remain virtual? This does not just impact students. It may impact staff, teachers and all of those people peripherally related to schools. Who needs to be on campus and who can remain remote?”

“Where can schools get help when and if they have to manage an infection cluster?”

ON THE DIFFERENCE BETWEEN ELEMENTARY AGE AND OLDER CHILDREN

Dr. Ibukun Christine Akinboyo

“We are seeing a difference in the way in which the infection presents itself. It seems to be milder in younger kids.”

“But I will say, particularly in our area, we have had child care settings that have been open … until recently we have not seen rapid clusters around spread in those settings. As the community prevalence has gone up, we have seen some clusters of spread among staffers, among children. And that is not unexpected.”

“I’m in full support of making decisions based on local data. That may be on the state level, that may be on the county level. We have to ensure resources are available across the board, so counties that historically have not had adequate access to resources have them.”

Dr. Charlene Wong

“When thinking about the risk of elementary versus high school students, we need to think both about the risk of infection but also the potential benefits and what’s developmentally appropriate for an elementary school student versus a high school student.”

“Developmentally, we think that maybe middle and high school students will be able to wear masks. That is probably not going to be developmentally appropriate or feasible for our younger children. So some of our mitigation strategies ... are going to look different in elementary versus middle and high schools.”

“High-schoolers are going to be more able to remote-learn than elementary students. Is it an ideal way for them to learn? Probably not for most high school students but they are better equipped developmentally to do that than a kindergartner, for example.”

“I am also in favor of these decisions being made more locally. The rate of community spread is very different in different localities across North Carolina and across the country. We are still not sure what the best way to open the different schools are – elementary, middle, high school – is it one week on, two weeks off? Two days in person with cohorts? This is going to be an opportunity for us to learn and to course-correct as we go. We probably won’t get it all right out of the gate. This is the first time we’ve tried to do something like this at this scale across the country.”

Lisa Gennetian

“It’s certainly true that adolescents are more likely to behave and be able to follow these rules. They are also more independent. The more we can think about respecting their social development as well as their learning, the more likely we’ll have success thinking about school openings and supporting their development.”

“It would be an error if every county and every city acted on its own. One of the beautiful aspects of the United States is this concept of trade and mobility across cities and counties and states. We’ve seen some success in the northeast because of some collaboration.”

“Some decision-making and guidance from above, in collaboration with what’s happening locally, is the way to point in the right direction.”

ON THE PANDEMIC EXACERBATING POVERTY

Lisa Gennetian

“Prior to the pandemic, poverty was already really high in the U.S. relative to peer nations, affecting one in five children. That number is expected to soar.”

“Children who are previously not poor are going to become poor, and children who are poor are going to be experiencing even further deprivation from poverty. Children of color are going to be hit hard.”

“Parents are losing jobs. Food is hard to come by. Evictions are expected to increase as rental forgiveness laws are meeting their deadlines this month. The U.S. labor market is not designed well to absorb formal care, whether it’s child care for early children or even monitoring and supervision of older children.”

“The U.S. lacks a strong safety net system for reaching vulnerable people. Schools have played a critical role in filling that gap.”

ON COVID CLUSTERS IN OTHER COUNTRIES

Dr. Ibukun Christine Akinboyo

“There have been a number of examples (of school-based infection clusters). … There have also been a number of countries, particularly in Europe, that have opened schools safely.”

“We can learn a lot. One of the main things is the only way to reopen schools safely is to have a comprehensive approach to reduce COVID-19 transmission in our community. That requires everyone, every single person who exists in the community has to play a part in reducing transmission.”

Lisa Gennetian

“It’s very tricky thinking about what we can learn from other nations. We don’t have a safety net in the way that other countries do. It’s just better everywhere else. It’s not that we don’t have it, it’s just a very different one. It’s more fragmented; a bit more inequitable. Designed to minimize fraud, not designed to protect children.”

“We just have a lot of heterogeneity and diversity in our population. As we’ve witnessed in the last few months, a lot of distress over that heterogeneity and how economic resources have been historically allocated. That kind of strife is not as present in many of our peer nations.”

ON LONG-TERM EFFECTS OF DISRUPTION ON KIDS

Lisa Gennetian

“We’re so focused on what to do now, it’s hard to have a vision of what the future will look like.”

“The combination of economic uncertainty along with overall distress does not fare very well for children. It will especially affect children in early years of development, their brain development. It will affect older children, too.”

“We have children graduating from high school with a real milestone of them going to college. We have young adults graduating from college with the real milestone of entering the workforce. What we’ve learned from prior economic recessions is that it is very, very, very hard for them to catch up. What happens is the pandemic will subside. This will pass. The economy will rebound and at those points, children will rebound. But there are going to be generations of children with negative effects for a very long time. It will be hard to recoup earnings for the current generation of children who are ready to enter the workforce.”

Dr. Charlene Wong

“For many children, in particular the most vulnerable children, this will be an adverse childhood experience. … This has been borne out across the country, across the world. Children who didn’t previously have a behavioral health diagnosis of depression or anxiety, having new diagnoses of depression or anxiety. Those who already had these diagnoses having exacerbations. I’ve had patients describe them to me as being stuck in an anxiety attack and having a really hard time getting out of that. Particularly for our older youth, they are very aware of the economic stress their parents and families are experiencing.”

Dr. Ibukun Christine Akinboyo

“We’re all worried about long-term effects. We also need to prioritize child-centered metrics both in how we’re reviewing the pandemic and how we’re monitoring the effect of the pandemic. It may seem like an afterthought, but children are our future and we can do better monitoring how this is affecting them.”

ON NC’s MANDATE THAT KIDS ATTEND SCHOOL IN PERSON FOR AT LEAST THE FIRST WEEK

Dr. Charlene Wong

“That could cause a spike in spread. This should be allowed to be an individual decision for each family considering the risks they have within their household. It is my opinion there shouldn’t be a broad sweeping mandate that children must attend in person … there should always be a remote learning option.”

Dr. Ibukun Christine Akinboyo

“We’re in a state where we are re-thinking everything. We re-think how we eat, how we buy groceries, how we go to the restaurants, gyms, how we take public transit. Now more than ever we need to re-think how kids go to school.”

“Approaching this in the best interests of children, we need to allow for some flexibility. We cannot have legal mandates that completely knock that out of the hands of the local administrators who are working on this.”

ON ANTICIPATING 2-WEEK QUARANTINES IF SCHOOLKIDS ARE INFECTED

Dr. Charlene Wong

“In many ways these unpredictable two-week quarantines for individual children or classrooms … can sometimes cause more chaos for families than what we saw with the blanket closures in the spring when all of us who were working parents were mostly in the same boat as we tried to juggle our personal and professional obligations.”

“What people can do now, including families, schools, and importantly, employers, is to prepare for these inevitable disruptions that we know are coming. Preparation now will help ensure that families will be able to follow these quarantine guidelines so that we can slow the spread of the virus and so schools can remain open for learning.”

ON OPENING SCHOOLS WHILE INFECTIONS CONTINUE RISING

Dr. Ibukun Christine Akinboyo

“The U.S. is quite unique in this situation. I do not know data in which schools were reopened in the context of what we’re seeing in the U.S. The rate of the infections of the U.S., compared to a lot of the other countries, we’re far higher. We would be the first to reopen schools in that particular context.”

“That being said, if we are addressing re-openings at a more local level, even at a statewide level, and you’re seeing lower prevalence, we can look at comparative countries that have similar prevalences and have reopened safely.”

ON RISKS TO TEACHERS

Dr. Ibukun Christine Akinboyo

“I don’t want to undersell the importance of teachers in all of this.”

“We also know that people that have to interact with kids consistently also pick up infections. We’re actually more worried about what’s going on with adults right now. We’re worried about long-term effects.”

“Any plan we make has to consider the impact on teachers. Yet, I’m also reassured there are a lot of protective measures that can be put into place if we can open in a community that has a decrease, a lower prevalence, that can reduce the chance that a child will transmit the infection to a teacher.”

Dr. Charlene Wong

“It’s so important to consider the teachers and, importantly, all the rest of the staff who work in the schools. The bus drivers, the folks who work in the cafeteria, the folks are going to help sanitizing the schools with greater frequency during this time.”  

Dr. Ibukun Christine Akinboyo

“This has disproportionately affected the Black and Latino population. A lot of our staff and teachers come from various backgrounds.”

“So as we’re approaching this, the whole point of a comprehensive approach in thinking of economics has to do with some of the prior issues or inequities that have already existed.”

Faculty Participants

Dr. Ibukun Christine Akinboyo
Ibukun Akinboyo is an assistant professor of pediatrics in the Division of Pediatric Infectious Diseases at the Duke School of Medicine and a medical director of pediatric infection prevention at Duke University Medical Center.
 

Lisa Gennetian
Lisa Gennetian is an applied economist who studies childhood poverty and how it shapes personal development. She is an associate professor of early learning policy studies in Duke’s Sanford School of Public Policy and a faculty affiliate in the Center for Child and Family Policy.
 

Dr. Charlene Wong
Charlene Wong is an assistant professor of pediatrics at the Duke School of Medicine and a primary care pediatrician specializing in adolescent and young adult care. She is also a core faculty member at the Duke-Margolis Center for Health Policy.

Duke experts on a variety of other topics related the coronavirus pandemic can be found here.